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Locked-in syndrome
| Image = CerebellumArteries.jpg | Caption = Locked-In syndrome can be caused by stroke at the level of the basilar artery denying blood to the pons, among other causes. | DiseasesDB = | ICD10 = | ICD9 = | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = D011782 | }} Locked-in syndrome is a condition in which a patient is aware and awake but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for the eyes. Total locked-in syndrome is a version of locked-in syndrome where the eyes are paralyzed, as well. The term for this disorder was coined by Fred Plum and Jerome Posner in 1966. , 197 pp. Locked-in syndrome is also known as cerebromedullospinal disconnection, de-efferented state, pseudocoma, and ventral pontine syndrome. Presentation Locked-in syndrome usually results in quadriplegia and the inability to speak in otherwise cognitively intact individuals. Those with locked-in syndrome may be able to communicate with others through coded messages by blinking or moving their eyes, which are often not affected by the paralysis. The symptoms are similar to those of sleep paralysis. Patients who have locked-in syndrome are conscious and aware, with no loss of cognitive function. They can sometimes retain proprioception and sensation throughout their bodies. Some patients may have the ability to move certain facial muscles, and most often some or all of the extraocular eye muscles. Individuals with the syndrome lack coordination between breathing and voice. This restricts them from producing voluntary sounds, though the vocal cords are not paralysed. Causes . ]] Unlike persistent vegetative state, in which the upper portions of the brain are damaged and the lower portions are spared, locked-in syndrome is caused by damage to specific portions of the lower brain and brainstem, with no damage to the upper brain. Possible causes of locked-in syndrome include: * Traumatic brain injury * Diseases of the circulatory system * Medication overdose * Damage to nerve cells, particularly destruction of the myelin sheath, caused by disease (e.g. central pontine myelinolysis secondary to rapid correction of hyponatremia) * A stroke or brain hemorrhage, usually of the basilar artery Treatment Neither a standard treatment nor a cure is available. Stimulation of muscle reflexes with electrodes (NMES) has been known to help patients regain some muscle function. Other courses of treatment are often symptomatic. Assistive computer interface technologies, such as Dasher in combination with eye tracking, may be used to help patients communicate. New direct brain interface mechanisms may provide future remedies.Parker, I., "Reading Minds," The New Yorker, January 20, 2003, 52–63 . Some scientists have reported that they have developed a technique that allows locked-in patients to communicate via sniffing. Prognosis Extremely rarely does any significant motor function return. The majority of locked-in syndrome patients do not regain motor control, but devices are available to help patients communicate. Within the first four months after its onset, 90% of those with this condition die. However, some people with the condition continue to live much longer References External links * Locked-in Syndrome Association's guide to communicating without language (French) Category:Neurotrauma Category:Syndromes